Plot Twists and Change of Plans Part II: Pregnancy, Beta hCG’s and Keeping it Together

We had it all figured out. I was supposed to start birth control pills last week so that we could time our trip to Prague for the frozen embryo transfer just right. We looked at flight availability with our miles, hotels etc., all was set up just right.

That all changed when, at 10 days past ovulation (DPO), I got a faint line on a pregnancy test. We were shocked and excited, but mostly scared. I guess all these months of trying naturally, a negative outcome after an IVF transfer, and a biochemical pregnancy in January kinda have that effect on your level of enthusiasm.

Besides, it was still very early. It was the first day I tested and at just 10 DPO (which would be the equivalent of 5 days past a 5 day IVF transfer, 5DP5DT) there’s plenty that can go wrong.

I’ll Show You Mine If You Show Me Yours

So I did what I do best. I started panicking and thinking the worst. You know, the natural thing to do when you just got the best news ever!

I snapped pictures of every single pregnancy test I took and used the eyedropper tool in Photoshop to compare line intensity. I’m sure I’m not the first person to do this, but it certainly adds to my reputation of being a weird and obsessive control freak.

The problem is, you have no control. There’s absolutely nothing you can do to assure this tiny little embryo sticks. Even if there was, I’m sure that worrying yourself to death isn’t in the top 3 of most beneficial things to do.

The rational side of me knows that. I like to think I’m 99% rational all the time but after all of this, I’d be happy to reach 50%.

When I wasn’t scrutinizing my own line progress, I’d be comparing my lines to that of other people online. Was my test darker or lighter than that lady why posted 5 years ago on a random internet forum? And what about this one? There are millions of pregnancy test pictures to be found online, and I’m “proud” to tell you I looked at nearly all of them.

Comparing my 11 DPO to my 14 DPO

Anyway, as the days passed, the lines kept getting darker and darker. At 14 DPO (or 9DP5DT if this was an IVF cycle) the test line was at least as dark as the control line.

So I called my OBGYN and was sent to get my hCG (pregnancy hormone) levels tested that same day.

Beta hCG Results and Pregnancy Viability

Obviously, I then started googling “hCG results at 14 DPO”.

There’s an excellent website called “betabase” that lists the average hCG values of successful pregnancies (also called “betas” because of the ß component that is tested of the hCG). The results are split by days past ovulation and separated for single, twin, or triplet pregnancies. For IVF, just add the number of days between retrieval and transfer/freezing to the DPO.

The data is all self-reported, which of course may not be completely reliable, but it does tell us something.

At 14 DPO, the median beta hCG of successful pregnancies is 130, with a range between 9 and 1,666. The variance is huge!

Most scientific studies investigating hCG values are based on IVF. This makes sense because most women won’t know exactly when they ovulated, so self-reported data can become pretty unreliable. But if you undergo IVF, every single milestone is recorded.

This study, for example, found that with a cutoff of >100 mIU/mL at 16 days past oocyte retrieval (equivalent of 16 DPO), the probability of an ongoing pregnancy was 90%. This means that (based on this particular study) in cases of hCG values above 100 mIU/mL at 16 DPO, the odds of having a viable pregnancy are very high. At a value of >300 mIU/mL, the likelihood of a viable clinical pregnancy was between 92% and 97%.

Another study looked at the predictive value of hCG 12 days after 2-day embryo transfer (equivalent of 14 DPO) and found a median hCG of 126 mIU/mL in viable pregnancies, and 31 mIU/mL in non-viable pregnancies. That’s a pretty significant difference. And at 201 mIU/mL, the average value among women carrying twins was almost double that of singletons. They reported that a cutoff of 76 mIU/mL worked best in predicting a viable pregnancy with good sensitivity and specificity.

Does that mean that a lower level (in this case between 29-45 mIU/mL) means you won’t have a successful pregnancy? Not necessarily. At that level, the chances of a biochemical pregnancy, a miscarriage, and a normal pregnancy are all around 31%. Not the best odds in the world, but not the worst either.

My Beta hCG Results at 14 DPO

Based on all of the above, I knew I wanted something above 76. Ideally above 100. Looking at the figure above, at a value of around 100 the rate of a miscarriage is about 15%, and the risk of a biochemical pregnancy and ectopic pregnancy are nearly non-existent. All while the chance of a live birth (singletons + multiples) are nice and high at 85%.

People always say it’s not the initial hCG value that counts, that it’s about the doubling after the initial value. While they certainly have a point, high scores by definition indicate that there must’ve been a big increase already. Betas of non-pregnant ladies are below 5. So a high initial score does certainly tell us something valuable.

After a long day of waiting, my 14 DPO beta hCG result came back at 221!

Much higher than I expected. I’m certain of my dates so there isn’t a chance of me miscalculating my DPO. The graph above has me in the last of the 10 centiles, where the chance of multiple or singleton births are both about 50%. Luckily, these studies are based on IVF, and I’m hopeful that most instances of multiples in the literature can be explained by double embryo transfers.

The Repeat at 16 DPO

I stopped testing after day 14. It only added to my anxiety and I already had enough of that going on. I convinced myself that if the initial beta came back above 100, I would stop worrying and just enjoy the wonderful news.

Well, I guess I lied to myself.

Not only did I not stop worrying, it only got worse. What if the 16 DPO betas came back below a 100% increase? What if it lowered?

The minimal 48-hour increase in hCG that doctors look for is around 53% to 66%. Ideally, it should be 100% or more.

The lab where I needed to get my blood drawn is about a 5-minute drive from home. We drive past it all the time. Still, Mr. Frugalcrib (who you could blindfold, spin around 10 times and he’d still be able to point out which way is north) managed to take wrong exits and turns. I guess we were both nervous. Mr. Frugalcrib edit: Hey, I told you I was taking the scenic route!

Anyway, we still got there in time and I had my blood drawn exactly 48-hours after my initial draw.

The agonizing wait began, again.

The next morning I got the call. My beta hCG results came back at 733! Holy sh*t. It more than tripled. Betabase reports a median of 291 (out of 3,229 women who had a successful singleton pregnancy). While the median for twins and triplets is 557 and 680, respectively. Even though my hCG levels came back pretty high, I’m not going to assume I’m hiding more than one in there. The ranges of what is considered “normal” are very large. There’s plenty of other stuff to worry about (trust me, I’m good at that!).

What’s Next

My OB’s office doesn’t want to see anyone before the 10th week of pregnancy. That means I still have 5 weeks to go. That’s a damn long time and, as most of my readers know, patience is not one of my strong suits.

But right now, I don’t care about that. The only thing I care about is seeing this through. Doing my best to keep my stress levels as low as possible and hoping to see our baby, with its vital organs in place, in May.

I’m still terrified. I honestly think women who’ve previously had an early pregnancy loss experience this phase very differently from those who conceive and carry on easily.

We don’t know what will happen next. The only thing we can go by at this point are the betas, and they look good.

If we make it to scan day, I’m sure I’ll be nervous for the next milestone, and the one after that. I don’t think it’ll stop if we finally do end up with a beautiful baby in our arms. Does it develop normally, is it gaining enough weight? Sidenote, I truly hope we don’t still call it “it” by then.

So I’m keeping my fingers tightly crossed for a good outcome. Preferably one where I keep my sanity intact! Edit: quick update, just entered the second trimester and things are still going well so far!

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Thanks 🙂 Very interesting question by the way. I found a paper that discussed spontaneous pregnancies after IVF and the authors found that, among patients with unsuccessful IVF, 24% conceived naturally afterwards. While that may sound high, the median time to pregnancy was 6 years, which gave these patients a monthly probability to conceive of 0.44% (compared to about 25% in the general population). In case you’re interested in the details: https://www.fertstert.org/article/S0015-0282(12)00396-2/fulltext.

I know studies have also found that in patients with unexplained infertility, or mild female/male factor causes, it’s often just as successful to wait and try naturally, than it is to do IUI. It’s what they call “expectant management”.
So it could be a simple effect of time that causes all of this.

I also think we tend to be more likely to remember cases that end this way, and forget about those that do end up having to go the IVF route, for example. It’s a sort of frequency illusion, if you will.